Mental Health (Veterans)

Tuesday 6th December 2011 Westminster Hall

11:00

[Hazel Blears (Salford and Eccles) (Lab)]

I am very grateful to have secured the debate. It has attracted interest from hon. Members on both sides of the House, who have offered me their support. Many hon. Members, in all parties, have pursued the issues relating to veterans for a considerable time and have been very effective in securing improvements in the way in which the country looks after and supports veterans.

I am here today because of a very special young man, Mr Neil Blower, who is one of my constituents. He is here to observe the debate. Incidentally, that is because of much appreciated help from Virgin West Coast Trains. We are glad that he has been able to make it here today. Neil is 28. He served in the Royal Tank Regiment for six years. He served a tour of duty as a peacekeeper in Kosovo and he was involved in the invasion of Iraq. He was in his tank when it was attacked at a vehicle checkpoint in Basra and he had the terrible experience of watching his sergeant be attacked and killed. He saw for himself the real and terrible horrors of war.

In 2005, Neil was discharged from the Army, suffering from post-traumatic stress disorder as a result of the horrific experiences that he had undergone. When Neil turned up at my surgery, I did not know what to expect. I thought that there would be issues about the practical help for veterans with mental health problems—issues about housing, employment and all the things that we associate with people adjusting to civilian life. What I did not appreciate was that I would meet someone who is incredibly articulate, passionate, committed and determined. Neil Blower is a very special individual indeed. I wanted to help him as much as I could in any event, but our discussion was quite enlightening to me. He told me not only of the problems that he had encountered when he left the Army—finding a home, looking for a job and trying to pick up the pieces of a normal life—but that he had discovered a new talent, a passion for writing, which had helped him to come to terms with the horrors that he witnessed during his Army service. He gave me his book to read. It is called “Shell Shock: the diary of Tommy Atkins”. There is a warning on the front cover that it contains strong language, and it certainly does, but it also contains a deep insight and a profound humanity. I have read the book. It has the power to move people and to make them laugh. It certainly made me laugh, but it also moved me to tears.

As I said, the book is called “Shell Shock: the diary of Tommy Atkins.” We all know the words of Rudyard Kipling in the poem “Tommy”:

“For it’s Tommy this, an’ Tommy that, an’ ‘Chuck him out, the brute!’

But it’s ‘Saviour of ’is country’ when the guns begin to shoot”.

Neil’s book is the diary of an ordinary soldier who has served in Iraq and Afghanistan, who has watched his friends die, who feels guilty that he has survived and who is struggling to come to terms with civilian life. If that sounds familiar, it’s because it is. That is why this debate is so welcome.

Luckily, combat stress and post-traumatic stress are now widely recognised by our armed forces, but that was not always the case. During the first world war, 266 British soldiers were executed for desertion, 18 for cowardice, seven for leaving their posts, five for disobeying a lawful command and two for casting their weapons aside. Some of those men were no doubt victims of shell shock. Their families had to live not just with the loss of their brothers, husbands and sons, but with the shame, anger and humiliation of their deaths at the hands of the state. In 2006, a conditional posthumous pardon was granted in respect of those individuals. That was a big turning point in how the country approaches these matters. We have come a long way in recent years in recognising the problems experienced by those who have been in battle, and Governments of both parties have taken action to provide improved health services for both physical injuries and mental health problems, but there is still more for us to do.

I pay tribute to Combat Stress, which does a tremendous job in helping veterans and is the UK’s leading military charity specialising in the care of veterans’ mental health. It looks after people who have post-traumatic stress disorder, anxiety, depression, sometimes phobias and certainly nightmares and flashbacks—all the things associated with having been in the heat of battle and having a mental wound as a result.

Last year, Combat Stress received more than 1,400 new referrals—that is the scale of the problem. It has a current case load of more than 4,600 individuals, including 211 who have served in Afghanistan and 583 Iraq veterans. In March 2010, its patron, His Royal Highness the Prince of Wales, launched the Enemy Within appeal on behalf of Combat Stress. That is a three-year fundraising campaign to try to ensure that Combat Stress has the capacity to continue to treat the increasing numbers of people who are now, happily, coming forward with the problems that they have developed. I understand that on average it takes someone who has developed anxiety and depression after having experienced the horrors of battle an unbelievable 13 years to come forward. For some, it will be longer, and for others it will be a shorter period, but that length of time indicates the embarrassment and shame that people still feel and the stigma that there still is around mental health problems. Of course, that is not limited to military life; there is still a huge stigma about mental health problems across society as a whole. But I think that, when people have been in combat situations, it is even worse.

[Sir Paul Beresford (Mole Valley) (Con)]

I am delighted to hear the praise for Combat Stress, which is located in my constituency. The right hon. Lady mentioned the figures. Is she aware that the rise in applications is running annually at about 12%, whereas the percentage of Government funding is dropping quite dramatically? I hope that she will touch on that.

[Hazel Blears]

Yes. The hon. Gentleman makes a very important point. The capacity of the people at Combat Stress to cope with the increasing number of referrals is of concern to all of us in the House, because they are specialists—they know what they are doing and are very effective. The best way to use Government funds is to put them into the services that we know achieve positive results, and Combat Stress has an excellent record. I will come to the issue of funding shortly.

Combat Stress provides very practical help. It is establishing 14 community outreach teams across the country. It has three short-stay treatment centres and it wants to enhance the clinical care that it provides at those centres; it wants to provide better clinical care. That is one of the uses to which any additional funds should be put. These are very specialised areas of intervention, and giving people the highest-quality clinical support is very important indeed. Since 2005, Combat Stress has seen a 72% increase in demand for its specialist services catering for veterans’ mental health problems. The services are free of charge to veterans, so they have to be financed through fundraising and from public sources as well.

A number of veterans leave the armed forces with very severe psychological wounds. Post-traumatic stress disorder can go on for a long time—for years, in fact. These conditions are not susceptible to easy treatment. Therefore, there needs to be a sustained commitment to funding and support for organisations such as Combat Stress.

Combat Stress also offers a 24-hour helpline. That provides confidential help not just to people who have been in the military, but, crucially, to their families. We sometimes forget the huge impact on the families of veterans suffering from mental health problems. If people commonly have nightmares and panic attacks, lose their temper and occasionally become violent, the impact on families can be enormous. The 24-hour helpline is therefore a practical way for people to get emergency help when a situation gets out of control.

Combat Stress has an expanding outreach service. It has a team of mental health practitioners, community psychiatric nurses and regional welfare officers. It has three centres, in Shropshire, Surrey and Ayrshire. In September, it introduced a six-week veterans programme, which provides enhanced treatment for people with complicated presentations—it is intended really to dig deep and to delve into all the symptoms people exhibit.

Combat Stress also has a well-being and rehabilitation programme, which is available to all the veterans in the short-stay treatment centres. The programme uses a really structured occupational therapy model, which draws on best practice in civilian mental health. It includes employment mentoring and life skills workshops, and it deals with the practical issues of rehabilitation so that people can take up social activities in the community, which they may have lost touch with while they had post-traumatic stress disorder.

Combat Stress is absolutely the leading organisation in this field in terms of expertise. It now has a partnership agreement with the Ministry of Defence and the Department of Health, and £350,000 of investment was recently agreed, which is, of course, very welcome. Despite that, however, Combat Stress is still feeling the pressure, as the hon. Member for Mole Valley (Sir Paul Beresford) said, and that pressure is likely to increase. I therefore asked it what it was looking for from Ministers, and I want to put to the Minister the points it raised so that he can address them.

First, Combat Stress is looking for increased recognition of the number of people who are beginning to disclose that they have post-traumatic stress disorder, especially given that an increasing number of servicemen are being withdrawn from the combat zones we have had in Iraq and Afghanistan. As these people come home, the pressures will build, and more and more of them will need services.

Combat Stress estimates that 960 of the service personnel leaving the armed forces in 2012 are likely to suffer from post-traumatic stress disorder, while about 4,700—a huge number to cope with—are likely to suffer from a more common mental illness, such as depression or anxiety. That is the nature of the problem. Combat Stress’s services are running at capacity and demand is going up, so my first question to the Minister is whether the MOD and the Department of Health, which is responsible for treatment, recognise that this problem, which will increase, should be firmly on the agenda.

Combat Stress’s second request is for increased capacity. The organisation is now extremely well known, so anybody who is in the circumstances I have described turns to it for help. The last thing Combat Stress wants to do is to turn people away because it does not have the facilities to cope. Can the Minister therefore tell us whether any planning is being done to deal with this issue? What proposals are there to meet the increased demand over the next few years? Where will the investment go? There will be investment in NHS facilities, but the facilities I am talking about, which are close to people and their families, can make a huge contribution in addition to that made by the NHS. I would therefore like to hear what specific proposals the Minister has to provide more funding, more resource and more capacity, particularly for Combat Stress’s outreach work and its 14 outreach teams, which will be extremely helpful for people suffering from the problems I have mentioned.

The third issue I want to raise with the Minister is the stigma around these conditions. There is much more to be done on this. Some 81% of veterans with a mental illness feel ashamed or embarrassed, which sometimes prevents them from seeking the help they absolutely need if they are to get well. One in three veterans—this is a very sad figure—are too ashamed even to tell their families about their mental health problems. I can only imagine what it must be like to live in a family with someone who becomes withdrawn, who is no longer part of the family, who suffers from all the symptoms I have described and who is often in a desperate state and too embarrassed to tell the other members of the family how they feel.

The Government—indeed, all of us—have a job of work to do to raise the profile of these issues and to remove the stigma around them. These things happen in conditions of war, and we should not be embarrassed or ashamed about them. We should do our utmost to help people in such circumstances. I welcome the MOD campaign on this, which is called “Don’t bottle it up”. It is a good way of starting to get rid of the stigma, but more could be done.

[Mr James Gray (North Wiltshire) (Con)]

The right hon. Lady is talking a great deal of sense. Allied to the question of stigma is people’s failure to recognise symptoms in themselves. People often suffer some of these things many years after the incident that caused them. Does she agree that another role the NHS could usefully play would be to advertise some of the symptoms and causes of these unfortunate mental disorders so that people actually recognise what is happening to them?

[Hazel Blears]

The hon. Gentleman makes an extremely good and practical point. The NHS runs public health campaigns about a range of issues that affect people, such as smoking and obesity. If we could normalise mental health in that way to some extent, people would feel much more comfortable about coming forward and saying they have a problem. One symptom of post-traumatic stress disorder is that people often resort to drugs or alcohol and end up with alcohol problems, not recognising that there are severe mental health problems underneath them. The prisons have recognised that about 50% of ex-service people in prison could well be suffering from post-traumatic stress disorder, and that is estimated to cost the nation about £300 million a year. This is a good example of a public health issue, and taking the approach I have described could not only result in significant savings, but contribute to the well-being of all those who are suffering. The hon. Gentleman makes a good point.

[Sir Paul Beresford]

On the same sort of theme, when veterans leave the forces, it is frequently 12 to 14 years before they present, as Combat Stress says. In the meantime, as the right hon. Lady has said, families, communities and so on can face havoc. The United States and the United Kingdom have a decommissioning period in which they help people leaving the armed forces, but ours is very short. The United States actually targets individuals so that they can be picked up and referred before they get into the community. The funding that she talks about will come predominantly from the NHS, and the Minister cannot really speak for the Department of Health. However, he can speak about what the Ministry of Defence can do to catch people early, before they do any damage to themselves or others.

[Hazel Blears]

The hon. Gentleman touches on a good point, which relates not quite to prevention, but certainly to early intervention before problems get worse. I am coming to the funding that will be supplied by the Big Lottery Fund, which will specifically target this issue, and it, too, is a good step forward. One issue is how we co-ordinate all the funding going through the NHS, Combat Stress and the Big Lottery Fund to make sure that we provide a really good wraparound service.

I want to say a word about the Big Lottery Fund investment. Over the next few years, the Big Lottery Fund will put £35 million into this issue. It is setting up a trust called Forces in Mind, which will provide long-term support and advocacy across the United Kingdom—it is important that ex-forces personnel have someone to speak on their behalf. The trust is about people making a successful transition back into civilian life. It will work with the people who have served in Iraq and Afghanistan. It will look at mental health, family breakdown and alcohol-related problems, which are absolutely pressing.

The trust involves a partnership between the Mental Health Foundation, the Centre for Mental Health, the Confederation of British Service and Ex-Service Organisations and the Shaw Trust. It therefore includes a number of good organisations that have reach into these areas, which is positive.

The trust had its business plan approved by the Big Lottery Fund board last month, and it has three early projects, which I will say a quick word about. The first is the early service leavers trial, and the hon. Member for Mole Valley touched on the issues it deals with. It is called “Future Horizons” and it is an enhanced transition programme for those who leave the services early, but who currently get no support from the armed forces. One thousand such people recruited from across the UK will go to Catterick garrison. They will get 12 months —this is a long-term programme—of enhanced support with finding jobs and accommodation, as well as guidance with educational problems and mental health issues. Twenty-six different community organisations are involved, so, again, there is good local reach. That is the beginning of what the hon. Gentleman seeks—an enhanced transition. It is no good giving people help for six weeks when they are looking for a job, trying to find a home and trying to get back into life. A 12-month programme will therefore be very helpful.

Another project will involve SSAFA Forces Help, which was the Soldiers, Sailors, Airmen and Families Association. It will work with the Mentoring and Befriending Foundation, TimeBank, Shoulder to Shoulder, the British Association for Counselling and Psychotherapy and Help for Heroes—again, it is a big consortium. Working with Cruse Bereavement Care, it will support people who are bereaved. Cruse is renowned for working with bereaved families. It is expert in counselling and support and will be a crucial part of the partnership, which will work with the widows, widowers, partners, children and siblings of those who have been killed, covering the whole range.

The other project, which will come on stream quite early, is with mentoring organisations. It will involve early service leavers who are under 24, so very vulnerable young people will get a specific mentor to help them through the transition—a buddy to be side by side with them, if you like. Younger people are often more vulnerable and their problems can be very long term. If we can intervene early, perhaps the transition can be more effective. The money from the Big Lottery Fund is therefore very welcome, but in my view it does not absolve the Minister from looking at other Government resources that might help. I am sure that we will all be interested to hear from him.

Neil Blower, my constituent, has made me much more aware of the problems faced by people than I ever was before, and I am grateful to him for that. I asked Neil, as I asked Combat Stress, what one thing he would really want to happen. What is his wish to help veterans in such circumstances? Neil has been lucky enough to be admitted on to the degree course in creative writing at the university of Salford and he has had his first book published—something that many budding authors never achieve. He hopes to go on to have a career as a writer, and I am sure that he will be successful. He wishes that there were a Tommy Atkins scholarship fund, and I would like the Minister to consider that seriously. It would be akin to the GI Bill in America, whereby the American Government paid for servicemen and women, after the Korean war, to go to university when they left the forces. That helped them to go from combat to classroom. Supporting some of our forces to realise their talent and potential through access to higher education would be a tremendous step forward.

Neil is busy costing the project and I am sure that we will come back to the Minister at a later date with a detailed proposition. Giving people the chance to have an outlet into higher education, whether to enter teaching or another important area of life, would help them with job seeking and give them more skills and a better chance in the labour market. Neil felt that, for him, education was a great way to deal with his mental health issues. It helped him enormously. He felt that he was doing something worth while, it made him feel as if he belonged and made him feel part of society again. The power of education therefore can be of tremendous benefit.

I am not on a sales trip, but Neil’s book is available and I urge as many Members as possible to get it. I did not know what to expect from that little volume. It is short, but incredibly moving, and I want to finish with a quote from it. I do not want to give away the ending completely, but in the book, Tommy Atkins is at the end of his tether. He has come home and life is terrible. He breaks up with his girlfriend, his mum and dad break up and a series of terrible events happen to him. I am sure that such things happen to an awful lot of people in these circumstances. He gets to the point where he is absolutely desperate and it is so difficult for him to carry on that he thinks of taking his own life, but then something kicks in inside his head: “This was a coward’s way out. I was a British soldier and we don’t do that. We never surrender and we never give up. That is for other people. I realise that, despite all the pain and heartache and suffering that there is in the world, there is good as well—there is good in this world. The love of another, the bonds between family, friendship—these are the things that I fought for. These things are still worth fighting for and they are worth staying alive for. I will love my mum and dad whether they are together or not. I just want them both to be happy. I will meet another girl and fall in love again. I will always remember the friends I’ve lost—Kev, Johnno, the serg, Jamie. I will honour their memory by living, by leading a good life. I stood in the mirror and looked at my medals, then I did the bravest thing I have ever done. I picked up the phone, I rang Combat Stress and I told them about me. I told them what I was feeling and I felt a great weight lifted from my shoulders.”

That, for me, is the best summary that I can give of the experience of Tommy Atkins and all those thousands like him. From this book, we can all rededicate ourselves to ensuring that we press for better understanding and better support to improve the lives of those who have given so much for all of us. I am grateful for being granted the debate this morning.

11:25

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I congratulate the right hon. Member for Salford and Eccles (Hazel Blears) on securing the debate. It is on an issue that I have spoken about on one or two occasions. I am delighted to say that in my maiden speech I gave warning and notice to my right hon. Friend the Minister that I was likely to carry on banging on about it. I am therefore grateful to have the opportunity to do so. A big problem with such debates is that the issues are covered by not only the Ministry of Defence but the Department of Health, and it would be helpful if we could, at some stage, get a Minister to come to talk about the health implications of what we want.

The right hon. Lady has given a very good briefing on Combat Stress, and I, like her, have been to talk to that organisation. It has been incredibly good at ensuring that I am kept informed and have an understanding of exactly where the problems are. Of course, we have heard a lot about the concentration and focus on veterans who have come out of Iraq or Afghanistan, but we must remember that people who were involved in conflicts in Northern Ireland will also need help. They also make up a significant number of the casualties who were created from that long and bloody conflict.

We talked at some length about how there will be an increasing number of people dealing with combat stress over the years. The Government have announced that we will withdraw from the Afghanistan conflict by 2014, but activities will continue there. During a trip that I made to Afghanistan a couple of weeks ago, I was told that although the troops will not go out on patrol, we will almost certainly need to support and help those in the Afghan army and police, who will need guidance. I am in no doubt at all that elements in the Afghan resistance will seek to ensure that our troops are subject to many attacks.

I grew up with these issues. My father went into the Royal Navy at 14, and was awarded the distinguished service cross for his activities in Narvik. He told me, when I was a child and a teenager, of how it was that he had been responsible for trying to take the head of one of the people he had served in a cabin with to throw it over the side when it was blown off in action. Fortunately, that did not have an impact on us as children. He was a very normal man and lived a full and active life until he was 89, but there was a real chance that such activity could have had a significant impact, not only on my mother, who, I have to say, had the most wonderful sense of humour, but on us, as children. We have all come out, I hope, reasonably sane and balanced.

The other day, I visited the Royal Marines in Exeter. One person told me a sad story of how when he had served abroad in action, he came back and wanted to talk to his wife about what he had faced. He wife looked at him and said, “Don’t start talking to me about any of that. I’ve had a damn awful day as well. I’ve had to deal with 300 e-mails, so that’s my priority”, so he did not talk to her about it. He tried to talk to his mates, who were not involved in the armed services, but they found it very difficult to understand, so he had to find his fellow servicemen—Royal Marine friends—who lived in Aylesbury, where he came from, and talk to them. It was only by having that opportunity to share his experiences that he saw what was going on.

I represent Plymouth, Sutton and Devonport, and it is a great pleasure to do so. We have just, literally, had 3 Commando Brigade come back from Afghanistan, and I think it also has some of the scars that come with that.

I am delighted that we have accepted the military covenant into law. I hope that the Secretary of State’s regular reports on that issue will be informed, and that we will be able to talk about mental health. I congratulate my hon. Friend the Member for South West Wiltshire (Dr Murrison) on writing the paper called, “Fighting Fit”. I think that that was the benchmark for ensuring that we were able to produce a strategy, and we are taking the issue more seriously.

I am also concerned about the reservists. We are enormously good at talking about regular service personnel, but we do not talk too much about reservists, although I know that my hon. Friend the Member for Canterbury (Mr Brazier) has been doing an extraordinarily large amount of work on this. I was talking to the British Legion the other day, and it told me how it did not seem possible to share information on reservists with charities that are delivering support and help. Could we look at that? Can we make sure that the information is much more readily available, so that people such as Combat Stress and the British Legion are aware of exactly where the issue is going to?

[Mr Gray]

There is a particular problem regarding the Territorial Army and reservists in general. Whereas a regimental family closes around someone among the regulars who is bereaved or has mental problems, and regulars tend to live in the same place as where they are serving, reservists often come from right across the land, and there is a much less strong regimental hierarchy to look after them. Reservists need particular help from the Ministry of Defence.

[Oliver Colvile]

I was just about to make that point. Those people work and live in isolation. The problems that they have with decompression are enormous. When they come back, they do not necessarily have the same amount of time as regulars do to unwind and be debriefed. We need to look at that issue. When I was talking to a senior Royal Marine the other day, he said that it would be helpful if the decompression time for reservists could be longer. I urge the Minister to consider that.

Another issue that we need to look at is how the national health service is dealing with the matter. As I said, the question is not just about how the MOD deals with the issue, although the Minister has been doing excellent work on veterans. I support the way in which we will change the structures of the NHS. I voted for the legislation, and I think it is the right way of going about it, but will our general practitioners and commissioning boards be able to manage the matter? If GPs commission such services, how far up the agenda is the mental health issue going to be? How will policies be implemented? Will we have lead GPs taking an interest? I will most certainly be asking my GP commissioning board down in Plymouth how it is proposing to manage the issue. We must think the matter through. We in this place can pass legislation easily, but we must ensure that it is implemented and that we monitor the results.

[Sir Paul Beresford]

That issue was raised with the previous Government. Some time between then and now, national commissioning of Combat Stress long courses was introduced. My hon. Friend is absolutely right about the recommendations of potential patients and about the other niche groups and niche courses. The Department of Health will need to look at the issue.

[Oliver Colvile]

I think that that is right. Local authorities also have to be involved. They will now take increasing responsibility for the matter. I was talking to the leader of my council last week, and she explained that until recently, the primary care trust had not been that interested in engaging on some of those big issues. I will be interested to know how that will happen. The whole story of mental health, as the right hon. Member for Salford and Eccles said, is an important issue.

We closely support our armed forces and veterans. Some of us—I happen to agree—are not convinced that we have handled the politics of what is going on in Afghanistan particularly brilliantly. However, if we are going to support our armed services, we must ensure that we look after them properly and that they come out with good results. How we deal with the issue of mental health will be paramount. As others have said, there are issues regarding licensing. In Plymouth, we have significantly more licensed premises than in Liverpool. That is a big issue. When people get depressed, they end up turning to alcohol and other substances. We must ensure that there is a joined-up and co-ordinated approach.

If we do not deal with the issue, we will have problems with our infrastructure, not only of the health service but of education. I heard a story that it is not mainly what comes out in the health stories but what happens in the home that is absolutely, utterly and desperately important. That is where all the problems kick off, and they do not become apparent until significantly later.

Mr Dobbin, thank you for allowing me to talk about the matter. I feel absolutely serious about the issue. It has been a great pleasure and honour to follow the right hon. Member for Salford and Eccles.

11:36

[Ian Paisley (North Antrim) (DUP)]

I, too, add my congratulations to the right hon. Member for Salford and Eccles (Hazel Blears) on securing this important debate today. Raising the profile of the matter will in itself do much to enhance public recognition of the issue, and she spoke passionately and poignantly about the need to achieve that.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) made an excellent point in his comments, which is that we must cast the net a lot wider than the immediate conflicts that we are aware of in Iraq and Afghanistan. It will not be unusual for Members to hear me speak about what has happened in Northern Ireland. We have a walking community of forgotten heroes who have served the nation well and with gallantry, from the Ulster Defence Regiment, the Royal Irish Regiment, the British regular Army and the Royal Ulster Constabulary. Only today, as the situation has normalised, has there been a true opening and unfolding of the trauma and devastation in the lives of individuals who gave service to this nation, and the effect that the conflict had on their families. Families lived with service personnel who not only served our country but lived within the community that they were serving—it was a double impact. It is only now, in this new Northern Ireland, in a more peaceful society, that that is starting to unravel and unfold. We must ensure, as we have started to peel back the issue and look at what could be an appalling vista, that we as a country recognise that we have a responsibility to address the concerns that we are starting to discover.

Several former soldiers, from the Ulster Defence Regiment in particular, visited me in my constituency office. They had stopped serving in the late ’80s and early ’90s, and yet they were still talking about things that they saw that are impacting their lives now. They look back and recognise that the awful pictures that flash in their memory have had an impact on how they have lived their lives in the past 20 years, and on members of their community and family.

[Mr Gray]

What the hon. Gentleman is saying with great passion brings to mind an episode yesterday. My hon. Friend the Member for Beckenham (Bob Stewart) was entertaining on the Terrace of the House of Commons one of the widows from the outrage of Ballykelly all those years ago, when 20-odd souls were killed in a pub. My hon. Friend was reminiscing about how he cradled his lance corporal in his arms. His lance corporal had lost all four limbs before he died. What sort of effect does that have, not on my hon. Friend—I am glad to say—who is remarkably well-balanced, but on any less well-balanced soldier? What possible effect will that have on the rest of their lives?

[Ian Paisley]

The hon. Gentleman makes a very important point. I also had a constituent who visited me about this problem. He was a big, strong, tough frame of a man, but he was like a quivering autumn leaf when he started to tell me about what he had seen and what he remembered. Indeed, his constant memory was the sound of the scrape, scrape, scrape of the shovel that he had used to put his comrades and colleagues into a waste disposal bag after an outrage by the Provisional IRA. It is a burning memory that he will never forget and that woke him in the dead of night, leaving him soaked in sweat and crying out in fear, and yet it is a memory that he has had to bottle up and carry with him.

As a nation, we must take responsibility and recognise that there are things that can be done for these people we are talking about. They are not hopeless people; they are people whom we can actually give hope to, if, as the right hon. Member for Salford and Eccles said, we first help to remove the stigma, and help people to recognise that there is help available and that they will not be stigmatised by going for that help. In fact, that help will only be of benefit to this community, this nation and indeed the NHS, which will have fewer problems to deal with as the years go on.

I hope that the passionate words that the right hon. Member for Salford and Eccles put to this House this morning will be recognised and that we also recognise that post-traumatic stress disorder is not only about the immediate battles that we are aware of today but about the long-term problems that our country faces. More than 100,000 gallant soldiers from our nation passed through Northern Ireland in service and we are just starting to scrape the surface of this issue when we recognise that, 20 or 30 years after the conflict ends, there could be people who will come forward to say, “I have a problem because of what I saw, because of what I witnessed and because of what I went through as a serving personnel officer in Northern Ireland.” We must ensure that that issue is properly recognised.

The right hon. Member for Salford and Eccles spoke about the capacity to take on board the cases that will come forward. I want to see that capacity extended, to ensure that the needs of Northern Ireland and of the soldiers there are also taken on board. The Big Lottery Fund money—the £35 million—that has been brought to our attention today will be a welcome spend and of course it must include spending on people who served in Northern Ireland under Operation Banner, to ensure that their issues are properly addressed.

I want to make a final point about the issue of stigma. We need a public champion who can be identified with this issue and whose association with it will give a boost and encouragement to those soldiers who are sitting at home, and perhaps staring into an empty glass, contemplating self-harm or having a fight with their children or other family members. That public champion will give those soldiers the ability to say, “There is someone who can help me; there is an organisation addressing what has affected me, and I can now see that I have someone to shoulder this burden and someone who can be a help or a crutch”, at the most important time—when they are at their most vulnerable. I hope that that public champion can be identified.

In addition, I love the idea of a GI Bill or something similar for the UK. There would be so much opportunity with such a Bill that we could build on, and I think that we could do things even better than they have been done in the US because this is a nation of people who come up with even better ideas than people in other nations do. We could learn from what has been done in the United States and come up with something really tremendous. I hope that this debate itself acts as a springboard and is a very hopeful and positive start to something that we can take great pride in.

11:44

[Stephen Gilbert (St Austell and Newquay) (LD)]

Thank you very much, Mr Dobbin, for calling me to speak. It is a great pleasure to serve under your chairmanship.

I congratulate the right hon. Member for Salford and Eccles (Hazel Blears) on securing this very important debate and on the passionate way in which she outlined her case on behalf of her constituent.

I think that we all know that there are about 5 million veterans in the United Kingdom and that a further 20,000 personnel leave our armed forces each year. Having recently returned from a visit to British forces in Afghanistan—a visit I was joined on by my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile)—I will take a moment to praise the work of the men and women in our armed forces. They put themselves in harm’s way and they do a terrific job under very difficult circumstances. Of course, it is not only the right hon. Lady’s constituent who is a hero, although I am sure that he is a hero; all the men and women in our armed forces are heroes and heroines too.

In addition, I think that we all know that the transition from military life to civilian life will always be challenging. Of the 20,000 personnel who leave the armed forces each year, about 10%, or 2,000, are discharged for medical reasons and of that number about 10%, or 200, are identified as having one form of mental illness or another. That group of approximately 200 personnel are only 1% of the number of personnel who leave the armed forces each year, but these numbers that I am citing are not insignificant. Last year, 164 personnel had to leave the armed forces due to psychological problems and of that number 35 were diagnosed with post-traumatic stress disorder. We have heard a lot this morning about PTSD, but it is not the mental health illness that is most commonly experienced by armed forces personnel. Depression, anxiety and alcohol abuse are far more prevalent, especially among young men leaving the service early. Indeed, those young men who leave the armed forces within four years of enlisting have been identified as a particularly vulnerable group.

[Susan Elan Jones (Clwyd South) (Lab)]

I am most grateful to the hon. Gentleman for giving way and to my right hon. Friend the Member for Salford and Eccles (Hazel Blears) for securing this debate. Does the hon. Gentleman agree that one very important issue in this debate is homelessness among veterans, which is closely linked with other problems affecting veterans? When I worked for a housing charity in London, I was struck by the fact that I did not have to speak too long to people working in night shelters before they made the point that there is always a certain percentage of veterans who are homeless on our streets, and that homelessness is a problem that is related to the other problems affecting veterans.

[Stephen Gilbert]

I am very grateful to the hon. Lady for that intervention, and she could not be more right about that issue. I chair the all-party group on housing and I have made it a particular business of mine to look at homelessness; in fact, I have applied to speak in an Adjournment debate on that very issue, Mr Dobbin. When I talk to organisations such as Centrepoint or St Mungo’s, it is absolutely clear that there is a particular problem with people who leave our armed forces and who are unable to adapt to civilian life and stabilise their housing needs. The hon. Lady makes a point that I hope the Minister will find time to address when he winds up the debate.

[Mr Gray]

I just wanted to intervene on that particular point, before the hon. Gentleman moves on. It is often anecdotally said that there are more people living on the streets who are from a service background than there are civilians and it is also anecdotally reported that there is a higher proportion of people in prison from the armed forces than there should be. However, I suspect that there has not been a proper statistical analysis of either of those issues and perhaps one of the things that the Government could usefully do is to come up with some hard facts to establish whether or not the anecdotal reports about those issues are actually correct.

[Stephen Gilbert]

My hon. Friend steals one of the key points that I was going to ask the Minister to respond to, but hopefully the fact that we are both making the same point will be better than just one of us making it, and so I am very grateful to my hon. Friend for that intervention.

The risk of suicide in army males under the age of 24 is two or three times greater than that of young males in the same age group in the general population. A recent study of 9,000 veterans showed that 20% of them had symptoms of common mental health problems and that 13% had symptoms of alcohol misuse. The right hon. Member for Salford and Eccles is absolutely right that we should be entirely clear that mental health issues can affect anybody in any part of the population, and that we should try to move away from the stigma that is all too frequently associated with those issues. Indeed, it is my understanding that 25%, or a quarter, of British adults experience at least one diagnosable mental health problem in any one year, and that one in six experiences such a problem at any given time. Mental health problems are very pervasive in our society and we must tackle the taboo about discussing them.

I have spoken before in the House about the harm that alcohol abuse can cause, and that same study of veterans showed that 40% of the veterans who responded met the criteria for heavy drinkers; 27% of them met the criteria for very heavy drinkers; and 15% of them were classed as problem drinkers. Again, young men in the armed forces are more at risk than young men in the general population, with 36% of 16 to 19-year-olds in the armed forces drinking harmful amounts compared to just 8% of 16 to 19-year-olds in the general population.

It is right and proper that we do all we can to help those who have served our country, and not only while they are serving but after they leave the armed forces. That is why I welcome the recent pilots by the Department of Health and the Ministry of Defence to ensure that NHS health professionals have the appropriate support and available expertise to treat veterans with mental health problems. The four national health Departments, the UK Ministry of Defence and the charity Combat Stress have been working together closely to develop and pilot a new model of community-based mental health care, and I particularly welcome the fact that one of the pilots is in Liskeard in Cornwall, which is close to my constituency.

Nevertheless, we need to see what else we can do. At the moment, the support offered for the reintegration of former service personnel into civilian life is proportionate to the time they have served but, as we have seen, those with mental issues and other illnesses often need the most help, and we need to consider whether we have right the balance between the time we are putting into their transition and their needs. We also must ensure that when people leave armed forces medical care, their transfer into the NHS is seamless. My hon. Friend the Member for Plymouth, Sutton and Devonport made it absolutely clear that we need to look again at what happens to our reserve and territorial forces when they are demobilised, as they are increasingly part of our war-fighting mix. I welcome the previous Government’s reserves mental health programme, which aimed to tackle some of these issues.

We must redouble our efforts to raise awareness in the NHS, to help veterans who are concerned about their mental health. And it is not just within the NHS; there is an issue closer to the Minister’s own Department. The MOD’s website has only one link buried within it to a charitable organisation that can help with these kinds of issues, and I ask the Minister to undertake to see whether the website could be looked at, and the links made more prominent, so that people who are clicking through will be better signposted towards help.

In all the defence establishments that I have visited during the 18 months I have been an MP, and before that as a parliamentary candidate, I have seen awfully large numbers of posters, notice boards and other ways of conveying information to our forces, and I wonder whether they are being adequately exploited to signpost our armed service personnel to the help that they need. As my hon. Friend the Member for North Wiltshire (Mr Gray) pointed out, we need more analysis and research into the wider consequences, and into whether we are providing the seamless support that we should, and to families as well.

Our service personnel never let us down. We ask them to do a difficult job under very difficult circumstances and they are prepared to make the ultimate sacrifice, so it is vital that this Government maintain the military contract post their departure from uniformed service. We must not let them down either.

11:49

[Mr James Gray (North Wiltshire) (Con)]

I did not intend to speak, and I see the little time available to us, so if I may I will hold the House for just a few minutes before the shadow Minister does her bit and the Minister, from whom I very much look forward to hearing, speaks.

First, I pay a warm tribute to everyone who has spoken so far in the debate, in particular to the right hon. Member for Salford and Eccles (Hazel Blears). She and I might not agree on many subjects, but on this one I think we are entirely ad idem. Everything she said was absolutely right. This issue is terribly important and she has raised it in a timely way. I also pay particular tribute to my next-door neighbour, in constituency terms, my hon. Friend the Member for South West Wiltshire (Dr Murrison), whose seminal work on this subject fulfilled a coalition agreement commitment to do something about the mental health conditions of the armed services. His report was extremely good, and it has given the Government a series of pointers as to what they can now do about this terrible problem.

I think that we are unanimous about the fact that there is this problem. I was struck by a conversation I had yesterday with my hon. Friend the Member for Beckenham (Bob Stewart), who sends his apologies for not being here. He was having a drink on the terrace with a young lady who was the widow of one of his soldiers. He recounted how when he was digging into the pub in Ballykelly, she insisted on calling him “sir” throughout the time she was struggling to escape from the mud and dirt, and how he said, “You don’t need to call me ‘sir’ under these conditions. Your husband is dead beside you; we can forget the ‘sir’.” What kind of effect can that kind of episode, in which someone cradles a dying soldier who has lost all four limbs, have on those who are left behind? My hon. Friend is one of the most well-balanced individuals I know, and I am not for a second suggesting that he has any such problems, but how many people will have had similar experiences in Afghanistan and Iraq, and how many soldiers who have had such an experience know what effect it will have on them in later life?

I remember speaking to a 19-year-old sniper when I was visiting Afghanistan last year. I asked him, “How many confirmed kills have you got as a sniper?” and he replied, “I’ve got 34 confirmed, and a further 26 probables”, so something like 50 or 60. I asked, “Doesn’t that worry you?” and he said, “No, sir, it’s no trouble at all. It’s a blur at the end of the sight, and I pull the trigger and do my job and that’s that. It has absolutely no effect whatsoever.” Who are we to say whether when that young lad is 50 or 60 he will have some form of effect from that experience? It is therefore incredibly important that we address this grave issue. I pay tribute to Help for Heroes and to my constituents in Wootton Bassett and across the area, who have done great stuff with bereaved families and soldiers coming back from theatre of war with injuries, but this is a much more invisible problem. We should be just as aware of it, even though the average time before a patient realises his problem is 14 years after the incident, and it may well be 20 or 30 years. It is important that as a society we do something about the problem.

Having agreed that—I am sure that everyone here today will strongly be in agreement—it is much more difficult to say precisely what to do. It is very easy to say, “Isn’t this an awful problem? Mustn’t we do something about it?” Well, yes, but what do we actually do? Two or three interesting proposals have come up in the debate. The first, and as I come from the Territorial Army myself I think this is very important, is that we should ask the reserve forces carefully to consider precisely what they can do. Very often, TA people coming back from the theatre of war leave the reserve forces within a year or two. They do not particularly want to carry on much beyond that, and they then disappear into civilian life and are gone for ever. We do not know where they are or who they are, and they may well be suffering from these same problems. We must find a way of pinning down where our reserve forces go when they retire, and do something about it.

[Mrs Linda Riordan in the Chair]

The second problem that people talked about very convincingly earlier was that of stigma and of people feeling that they do not want to come forward, and I think that that particularly applies to the testosterone-filled young men we send off to war—and women to a degree, but not the testosterone. They come back and do not want to say, “I’m a bit daft. I’ve gone a bit loopy. There’s something wrong with me.” The ethos is not to say that, and we have to find a way of encouraging them to believe that it is a normal thing to do, that they can perfectly sensibly bring themselves forward and say, “I’ve got a problem here, and I need some help.”

One thing we might want to think about doing is this. Some 10 or 15 years ago, our servicemen coming back injured from the theatre of war felt very uncomfortable being in civilian wards in Birmingham. No one is saying that they were not well looked after, but only a year or two after the conflicts began the previous Government introduced military-style care in Birmingham. Armed servicemen feel at home and relaxed in such an arena, and I think that something similar has to apply to mental health. Too many civilian mental health workers do not understand the problems, which may well present many years after the incidents that cause them. Particularly in areas such as mine and that of my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), where there are very large numbers of armed servicemen, we have to find a way of saying to our primary care trusts, “This sort of problem is coming your way over the years. You have to find a quasi-military way of dealing with it. You have to realise that military life is different from civilian life and that these are different problems from civilian mental health problems, so let’s find a specifically military way of dealing with them. Let’s keep in touch with the armed services and find out precisely what they know about post-traumatic stress disorder and the rest of it, and let’s find a military solution to what is a military problem, albeit within a civilian environment.”

This has been a useful debate. We have raised the issue very satisfactorily and the armed services, which are aware of the problems, will, I think, be grateful to us for having done so. But it is very easy to do two things. First, it is easy to exaggerate the problem, and it would be useful if the Minister could initiate a statistical analysis of how many people it affects in a real sense. Earlier, we discussed prisons, alcohol and homelessness. How much of that is caused specifically by combat, and how much is in the normal run of human beings? There are 200,000 people in the armed services. A number of them will be drunken or homeless. That is the nature of the beast. How much of that is caused by military service, and how much is incidental to it?

So first, we must not exaggerate the issue. Secondly, we must not just take political capital from expressing our sympathy and concern; in debates such as this, we must make specific proposals about what we can actually do to lessen this problem in our society. I look forward to hearing from the shadow Minister and, perhaps more importantly, from the Minister, on what we can do about this dreadful problem.

12:00

[Gemma Doyle (West Dunbartonshire) (Lab/Co-op)]

I, too, congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears) on securing this debate on an important and topical issue. More importantly, I thank Neil for coming along today and allowing us to hear his story, which has both provided a context for our discussion and put a face on the issue that we are debating.

I welcome the opportunity to discuss these issues with the Under-Secretary of State for Defence, the right hon. Member for South Leicestershire (Mr Robathan). We have spent much time during the past year discussing the Armed Forces Bill and the armed forces covenant. The Bill has now received Royal Assent, so it is perhaps fitting that as we come to the end of the year, we are again discussing the welfare of our brave serving personnel and veterans and the impact on their families.

My right hon. Friend painted an honest and vivid picture of the problem of veterans’ mental health. It is easy to be preoccupied with the scenes from Afghanistan that we still see and not to pay as much attention to the issues facing service personnel and their families when they leave the forces or return from theatre. We know that they are skilled, highly trained and resilient people, but more than 180,000 personnel have served in Iraq, Afghanistan and elsewhere, as we have heard, and a significant number will have returned with mental ill health or will, sadly, go on to develop problems later in life. We should be prepared to deal with that and ensure that the right facilities and support are in place to diagnose and treat such conditions.

Significant progress has been made in recent years, particularly through mental health pilot schemes and work done since then, to improve support and treatment for personnel suffering from mental health problems, but no party has a monopoly on wisdom when it comes to improving services for our forces. We have all met constituents who have told us about their experiences. We have heard about some of those and about Members’ personal experiences of the issues.

I emphasise the importance of the current campaign by Combat Stress about the stigma attached to mental health, which my right hon. Friend mentioned. Combat Stress provides an invaluable service to veterans around the country. Its centres and outreach work allow veterans to get the help and support that they need in a specialised environment, along with other veterans going through similar experiences. Combat Stress’s “The Enemy Within” campaign seeks to tackle the stigma that, unfortunately, can be a barrier to people getting the support and help that they need.

However, the work of Combat Stress and of many other important organisations and charities such as the Royal British Legion should not give the Ministry of Defence or the Government an excuse to opt out of their responsibilities, or indeed ours. It is important that we do not view the services offered by the voluntary and charitable sector as a replacement for acting ourselves. Such organisations should complement, not replace, the services that the Government offer. The voluntary and charitable sector is facing a tough time at the moment. Forces charities are spared some of that pain by generous ongoing public support, but we should not assume that those services will always exist and will always have enough funding to run.

Government should decide what services they have a duty to provide and should fund them properly. The Government need not always be the vehicle to deliver those services, as we have heard, but they can fund experts such as Combat Stress to do so on their behalf. This Government should also consider how mental health services for veterans or anyone else who needs them can be guaranteed when their national health service reforms are removing accountability. Again, we have discussed that already.

Those in the forces are trained to be strong, resilient and able to push through any challenge that stands in their way. That does not lend itself easily to admitting that one needs help because of a mental health problem. My right hon. Friend highlighted the high proportion of veterans suffering from a mental health condition—a staggering 81%—who are embarrassed by or ashamed of their condition and do not feel able to come forward. We have also discussed the average length of time it takes people to present in search of support, which is about 13 years. I understand that there are examples of people who have waited up to 40 years to get help. We must do all that we can to change that situation. We cannot just let it continue.

Combat Stress has also provided detailed evidence involving cases of individuals who have faced marriage break-up, unemployment, social isolation or substance abuse, all because they were unable to deal with their mental health. My hon. Friend the Member for Clwyd South (Susan Elan Jones) mentioned homelessness as well. We should be concerned about the figures, and I agree that it is right that we should seek to quantify the problem. The figures show that, even though help and support exist, too many people still find the stigma far too great to overcome. Until we tackle that stigma, no matter what support is out there, there will be no real change. Combat Stress’s campaign focusing on the issue of stigma is vital.

We have spent much of this year’s parliamentary debates on the forces discussing legislating for the covenant, so it is welcome that we are now debating the substance of the issues covered by the covenant and what it should mean in practice. It is right that nobody who serves their country in the forces should be disadvantaged as a result of their service. In some ways, however, getting the Government to enshrine that in law was the easy bit. The Government must now take action to implement the covenant so that we can see what it means in practice. I would welcome information from the Minister about the planned implementation of the covenant and how the Government intend to ensure that Departments and public bodies audit and change their policies to give our forces, our veterans and their families a fair deal.

My right hon. Friend highlighted the need to recognise how many veterans suffer from mental health issues. My hon. Friend the Member for North Durham (Mr Jones), the previous veterans’ Minister, announced plans when he was in post for a veterans’ ID card. The card would have enabled veterans to be identified easily and to get priority NHS treatment.

As we have discussed, it is difficult to quantify the level of need. Without a tracking system for veterans, we will never be able to do so. My right hon. Friend has asked in written questions how many ex-service people are being treated for mental health problems on the NHS, but there is no record, so the Minister replying was simply unable to give an answer because the data do not exist. Being unable to quantify the problem makes the Government unable to quantify the true cost of treating mental illness among former members of the armed forces. Therefore, the true impact is unknown at the moment. A veterans’ card would enable the Government to track veterans and offer the right support to those who need it.

In the Armed Forces Bill Committee, on which the Minister and I both served, the Minister reiterated his opposition to introducing an ID card, but the Government agreed earlier this year to launch a veterans’ privilege card allowing veterans to access commercial discounts. That is welcome, but I urge the Minister to look beyond discount schemes and extend those proposals, and to use the card as a way to ensure that veterans can access the support that they require when they need it.

[Mr Gray]

I am puzzled as to why the deeply bureaucratic and complicated system of issuing 5 million people with a piece of paper would help those suffering from mental stress many years after service to come forward and ask for the help that they need. I am not certain as to why that is a solution to the problem under discussion.

[Gemma Doyle]

The proposals were not overly complicated. The initial proposal was to start issuing a veterans’ card to people who are leaving the services now, not necessarily to go back and identify the 5 million people, because, as the Minister has told me, he cannot identify them. If we do not start to make some changes, we will never be able to quantify the problems. When we are able to know who the people are, the right support and services can be offered to them and contact can be maintained where it is wanted to ensure that the services are being delivered. Then, when an individual presents with a mental health problem, they can clearly be identified as a veteran and we will be able to see the problem much more clearly.

[Sir Paul Beresford]

The point made by the right hon. Member for Salford and Eccles was that many of these people will not present themselves and do not understand the problems, and that asking them will not get the result that the hon. Member for West Dunbartonshire (Gemma Doyle) seeks. That is why I have insisted— I think this point was raised earlier—that the decommissioning that is done in the States, and to some degree here, might be the answer, without the paper.

[Gemma Doyle]

No one measure will sort out this problem—there needs to be a range of measures. I think that, taken together, the hon. Gentleman’s suggestion and mine would help to address the problem. I do not think that we will be able to quantify the issues unless the data and the systems are in place.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) has already mentioned that it is important that we do not overlook the particular impact of deployment on the mental health of our reservists. Professor Simon Wessely of the King’s Centre for Military Health Research states that reservists who have served in Iraq or Afghanistan are three times as likely to suffer mental health problems as members of the regular forces. The Government’s Future Force 2020 plan suggests that the role of reservists is to increase substantially as a result of the reductions in the number of regular service personnel, so the Government must have the support in place to ensure that reservists are prepared to take on those extra responsibilities and that extra role, as well as guarantee that they have access to the correct mental health care and support when they return from deployments or are no longer mobilised.

As in the rest of the forces, there has been progress in recent years. The reservist mental health programme extended mental health support for reservists, but, with their role set to increase, the provision of support will have to be pointed in the right direction to cope with the increased number of reservists who are to be deployed. I would therefore appreciate an assurance from the Minister that the mental health care of reservists will be given due attention.

In conclusion, I again congratulate my right hon. Friend the Member for Salford and Eccles on securing this debate. We have heard of experiences from around the country, and they have illustrated the need for attention not to be diverted from the issue. The hon. Member for North Wiltshire (Mr Gray) asked what measures we can and should take to improve the situation. Combat Stress is asking for five things. I do not think that I can improve on them and would welcome the Minister’s comments on them. This debate has given us the opportunity to recognise the role that the NHS, the Ministry of Defence and Combat Stress play in supporting the mental health and welfare of our veterans. I pay particular tribute to Combat Stress, which, along with many other service organisations and charities, plays an outstanding role in support of the whole armed forces family, for which we should thank it.

12:14

[The Parliamentary Under-Secretary of State for Defence (Mr Andrew Robathan)]

This is a hugely important topic, so I am delighted that the right hon. Member for Salford and Eccles (Hazel Blears) has secured this debate. I thank all Members who have taken part. The right hon. Lady is a former Minister with responsibility for public health and therefore knows a lot about the issues. I am not in any way clinically trained, so I tread very warily around issues of mental health. We should be wary of making grandiose statements on a very complex situation. I certainly try not to tell clinicians how to address it.

There is, however, a good story to be told. A great deal of progress is being made and the subject has rightly received a lot of attention in recent years. Our armed forces are currently deployed in the most demanding areas of conflict, and we have a moral duty, not only as a Government but as a nation, to support and look after them, to care for them when they are injured and to maintain that care when they leave service. Mental health problems, as we have heard, may take some time to manifest themselves, in some cases many years after service. Mental ill health can be a truly debilitating condition. As several Members have mentioned, it still has a stigma attached to it, and I believe that there is a lot of common ground across the political parties to remove the barriers for those seeking the help that they so desperately need.

I acknowledge the work of the previous Administration in launching ex-service mental health pilots throughout the country during the previous Parliament. Such was their success that they continue in the NHS, which is leading the fight to ensure that those who need our help receive it.

Although I am responding on behalf of the Ministry of Defence, it has been the policy of successive Governments that the treatment of all health-related conditions and problems for those who have been in service is the responsibility of the national health service. I mention that because I deal very closely with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), who from time to time makes comments in the House about zombies—some Members may have noticed that recently—that may have deflected us from his excellent work in the Department of Health, especially his close work with us on various issues, particularly mental health. Indeed, he and I together visited Combat Stress in Leatherhead about a year ago. The NHS and the MOD together have also set up armed forces networks to ensure that ex-service personnel in particular can access health care. Members have said that people do not understand what ex-service personnel need, but this should go some way to helping in the future.

To ensure a coherent approach across the Government, my right hon. Friend the Prime Minister asked my hon. Friend the Member for South West Wiltshire (Dr Murrison), who served as a medical doctor in the Royal Navy, to conduct a study into the relationship between the national health service and the armed forces, including former servicemen, in terms of mental health. It was a thorough examination of our procedures and led to my hon. Friend’s well-respected “Fighting Fit” report. If hon. Members have not read it, I commend it to them.

The right hon. Member for Salford and Eccles asked about our plans for the future. Essentially, they are based on that report. The former Defence Secretary, my right hon. Friend the Member for North Somerset (Dr Fox), announced on 6 October last year that we would accept all of the “Fighting Fit” recommendations. They include a scheme, beginning next spring, routinely to contact service leavers at the 12-month point after discharge to establish whether they have any health need for which they are having difficulty in accessing treatment. That is actually very difficult, because when people leave the armed forces, they often change address, move away, go abroad or do all sorts of other things. It is not as easy as one might think. In addition, we will enable those identified as having a mental health problem during service to continue to have access for up to six months to the MOD’s departments of community and mental health. That will help smooth the transfer of care from the MOD to the NHS. We have also enhanced service medical examinations to enable earlier identification of mental health problems.

One of the earliest “Fighting Fit” recommendations to be implemented is the new 24-hour helpline, which is run by the charity Rethink on behalf of Combat Stress and is funded by £200,000 from the Department of Health. It allows former personnel with mental health problems and their families to get specifically targeted support from people trained and experienced in dealing with serving and former armed forces personnel and their often complex mental health needs. It is a real success, and when I have met Combat Stress and its clients, I have seen for myself how important this enabling of the first step to seeking help really is. I telephoned the helpline shortly after it was set up because I am sometimes slightly sceptical about helplines, and I can assure hon. Members that it works.

Through working with Combat Stress, the NHS is also increasing the number of mental health professionals, with a focus on providing help to veterans with mental health problems. That provides the opportunity for veterans to be seen locally by NHS professionals who have a better understanding of veterans’ needs, working side by side with Combat Stress outreach teams and their extensive experience and knowledge.

To help with the process of removing the stigma, to which several hon. Members referred, the Government have introduced an online well-being network that is accessible to serving personnel, their families and veterans. It is called the Big White Wall and is staffed by professional counsellors, who can be contacted 24 hours a day, seven days a week. That social network, which is reflective of today’s society, allows individuals to engage with others who are in similar difficulty. The anonymity connected to that network allows for a free and frank exchange of experiences, with a view to generating a wider sense of support. The Big White Wall has logged 1,000 hits since going live, more than 40% of which are from serving personnel, which illustrates that it will be a success.

I must acknowledge the significance of Combat Stress’s collaborative approach with the NHS and the MOD, which was referred to by the right hon. Member for Salford and Eccles and others. I bought my Christmas cards this year and last year from Combat Stress, so I would like to think that I do my little bit personally to support it. My Department provided Combat Stress with £3 million in the financial year 2010-11 for the treatment of those in receipt of a war pension who require treatment for mental health problems caused by service.

Combat Stress was formed shortly after the first world war to help those returning from the battlefields, but it is as important today as it was then. Indeed, I first came across Combat Stress 25 years ago when I was serving. It was known then as the Ex-Services Mental Welfare Society. We have heard today about Neil Blower, a former serviceman who served his country in Iraq and Kosovo. He experienced difficulties after service, but received excellent help and support from Combat Stress. He has now become a published author. I wish him continued success, and I should say to the right hon. Lady that I found the quotation from his book very moving.

I accept that the Government cannot and should not do everything. Through the armed forces covenant, we are building partnerships between all arms of government—national and local—and with the NHS to deliver better support to the armed forces community. The hon. Member for West Dunbartonshire (Gemma Doyle), who speaks for the Opposition, mentioned all arms of government and how we need to bring them together. A report on the covenant will be published before Christmas.

We also need to work more closely with the charitable sector to get the right support to the right people at the right time. The covenant has the important principle of removing disadvantage. Any former serviceman who is ill as a result of their service can access priority treatment through the NHS—subject, of course, to the clinical needs of others. We continue to work closely with GPs to make that more widely known because there is an education issue. The Department of Health, working with the Royal College of General Practitioners, has put in place an e-learning package for GPs. That will increase awareness of the status of patients who are veterans, thus enabling more proactive monitoring of veterans’ mental health and helping to ensure that they receive the treatment that they deserve.

We acknowledge that, in some cases, it can take years for psychological problems to manifest themselves. It is therefore important that we recognise through-life responsibility to our armed forces and that we do all we can to increase awareness and reduce the potential for developing mental health problems in the future.

[Hazel Blears]

If the Minister’s plans to reduce stigma are successful—and I very much hope that they are—that will inevitably result in more people presenting for treatment and help and support. I specifically asked him what his estimate is of the increase in the number of people presenting for next year and the years after as troops withdraw from the theatres where they have been active and what plans he has to meet that increase in the number of people presenting. I would appreciate some detailed answers to those specific questions.

[Mr Robathan]

I was going to come to that, but we do not have estimates for the figures that may emerge because it is a very difficult clinical situation. Some people—mostly not qualified doctors—say that a tidal wave of mental health problems is coming. I do not know whether that is the case, but what I do know is that we must be ready for whatever comes, so that we can help ex-service personnel. That is the right way forward, but making estimates that must inevitably be guesses because they depend on individual situations would not necessarily be very helpful.

I want to answer a few more of the right hon. Lady’s questions. We have mentioned stigma. It is our policy and that of the armed forces that mental health issues should be recognised properly and handled appropriately. Every effort should be made to reduce the stigma associated with such problems. Service personnel are given briefings before, during and after any operational deployment that explain the symptoms to look for and signpost the support services available. As well as medical officers, welfare staff, mental health personnel and chaplains also deploy to places such as Afghanistan and are available to provide help and advice.

One of the most successful recent innovations has been the introduction of trauma risk management—TRiM—which I have seen. That is a process of peer-group risk assessment, and mentoring and support for use in the aftermath of traumatic events. Such a process is undertaken as soon as possible after the event. That could happen, for example, after a patrol in a forward operating base. Evidence suggests that that process has been successful in increasing awareness and reducing the stigma attached to mental health disorders, which the right hon. Lady mentioned.

Away from the operational theatre, we provide a range of specialist care, primarily through 15 military departments of community mental health across the UK and four such departments in Germany. Those departments provide out-patient mental health care and are staffed by community mental health teams comprising psychiatrists and mental health nurses, with access to clinical psychologists and mental health social workers. In-patient care, when necessary, is provided regionally in specialised psychiatric units under a contract with the NHS.

To help our understanding of the issues that affect service personnel and those who have left the services, we fund a large-scale research project at King’s College, London on the experiences of those who are serving or who have served in Iraq and Afghanistan. Only last Monday, I spent the morning at King’s with Professor Simon Wessely and other academic staff who are undertaking that research. If anyone wishes to go there, I can arrange a visit because they are extremely on the ball and know an enormous amount about the subject, as one would hope. The project includes a large-scale study involving more than 20,000 participants, which is monitoring the effects of operational service compared with a cohort group that did not deploy.

In May 2010—the project was funded by the previous Government—the latest phase of that research confirmed that there is a continuing relatively low prevalence of probable post-traumatic stress disorder for the UK armed forces. Some 4% of respondents displayed symptoms of PTSD compared with other studies that show a range of rates between 3% and 7% in the general population. Recent evidence suggests that PTSD is likely to present at a peak of about three years, but we accept that it may be longer in some cases. It is therefore important that we recognise our through-life responsibility to our armed forces.

I will try to cover the questions asked by hon. Members. My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) made some excellent points. The hon. Member for North Antrim (Ian Paisley) spoke with passion about the legacy of conflict in Northern Ireland. Having spent the best part of a year of my life on the streets of west Belfast, I have a very real understanding of and a great deal of sympathy with some of his points. The hon. Member for St Austell and Newquay (Stephen Gilbert) spoke with great feeling, but we should be careful that we do not see ex-service personnel as victims. They are very capable people, and the overwhelming majority of people who leave the services plough a pretty good furrow and get a job. I had to become an MP to get a job; nevertheless, most people get a pretty decent job after they have left the armed forces, and they do not want to be patronised.

My hon. Friend the Member for North Wiltshire (Mr Gray) added his experience of the Territorial Army and acknowledged the real difficulties that we face. On the reservists, he is absolutely right. I say gently to the hon. Member for West Dunbartonshire that we must understand—I think that she does understand—that many ex-service personnel do not want to be pursued. When they leave the armed forces, they do not want to be followed up.

The right hon. Member for Salford and Eccles particularly mentioned education. I will write to her if I may with the details, but I think that she will find that the further education scheme funded by the Department for Business, Innovation and Skills provides free tuition for service leavers undertaking a first qualification at that level. That gives ex-service personnel the opportunity for higher studies, which they may have been denied by military service. Furthermore, they can build up learning credits during service that can be used to fund education for up to 10 years after leaving service. However, I will write to her with the details on that.

In conclusion, there is consensus here. The right hon. Lady has raised a very important issue. We can never remove the exposure to trauma in operations, but we must do all we can to minimise the effects that that might have. TRiM on the battlefield gives the opportunity to discuss the shared experience of trauma, and that concept is continued with the Big White Wall. For some, medical intervention is required, which I have discussed, but we continue to address the recommendations made in “Fighting Fit.” All that is complemented by Combat Stress and other service charities. As we have heard, they do a huge amount to rebuild lives, and we are, as a Government and a nation, eternally grateful for that.